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Effect of Muscle Energy Technique on Pain Perception and Functional Disability of Women with Postnatal Low Back Pain

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Effect of Muscle Energy Technique on Pain Perception and Functional Disability of Women with Postnatal Low Back Pain British Journal of Medicine & Medical Research 4(33): 5253-5261, 2014 SCIENCEDOMAIN international www.sciencedomain.org Effect of Muscle Energy Technique on Pain Perception and Functional Disability of Women with Postnatal Low Back Pain Asmaa M. El-Bandrawy 1, Marwa A. Mohamed 1* and Ahmed M. Mamdouh 2 1Departement of Physical Therapy for Obstetrics and Gynecology, Cairo University, Egypt. 2Departement of Obstetrics and Gynecology, Ain Shams University, Egypt. Authors’ contributions This work was carried out in collaboration between all authors. Author AME designed the study, wrote the protocol and managed the analyses of the study. Author MAM performed the statistical analysis, wrote the first draft of the manuscript and managed the analyses of the study. Author AMM managed the literature searches. All authors read and approved the final manuscript. Received 20 th September 2013 th Original Research Article Accepted 29 April 2014 Published 20 th July 2014 ABSTRACT Aims: To determine the effect of muscle energy technique (MET) on postnatal low back pain. Place and Duration of Study: Department of obstetrics and gynecology, Ain Shams University Hospital, and Outpatient Clinic of Faculty of Physical Therapy, Cairo University, between January and May 2013. Methodology: This study was carried out upon forty women diagnosed as postnatal low back pain. They were selected from outpatient clinics of gynecology of Ain Shams University Hospital, Cairo University. Their age ranged from 25-35 years, BMI<30kg/ m², they were all after normal vaginal delivery using local anaesthesia. Patients with radicular pain distal to the knee, previous low back surgery, low back pathology diagnosed by a physician, spondylolisthesis and chronic low back pain were excluded from the study. They were randomly assigned into two equal groups (A& B). Group (A) consisted of twenty subjects, with an average age 29.2±1.9Yrs, and BMI 27.28±2.1kg/m 2 who received MET. Group (B) consisted of twenty patients, with an average age 28.58±2.2Yrs, and BMI 28.92±0.7kg/m 2 who received sham technique. A hot pack was used for 15 minutes for both groups (A&B) before the treatment. This is to decrease ___________________________________________________________________________________________ *Corresponding author: Email: [email protected]; British Journal of Medicine & Medical Research, 4(33): 5253-5261, 2014 pain, muscle spasm, and provide vasodilatation of the blood vessels supplying the area. The MET was applied three times per week for four weeks for patients in group A, and the sham technique was applied three times per week for four weeks for subjects of group (B). Assessment of all subjects in both groups (A&B) was carried out before and after the treatment program using Visual Analogue Scale (VAS) and Stratford Back Pain Functional Scale (BPFS). Results: There was a statistically highly significant decrease (P<0.001) in VAS scores and a statistically highly significant increase (P<0.001) in BPFS, after 4 weeks of the treatment program for group A than group B. Conclusion: Muscle energy technique is an effective and safe method in alleviating postnatal low back pain. Keywords: Muscle energy technique; low back pain; postnatal period. 1. INTRODUCTION Low back pain is very common, and affects 70–85% of adults at least once during their lifetime [1]. Low back pain can be very severe causing sharp shooting pain or it can be a mild pain such as a dull ache. In most cases a person can recover without needing to seek medical attention, recovering within a couple of days up to 6 weeks [2,3]. Back pain is considered a normal consequence of pregnancy caused by mechanical and hormonal changes and is expected to disappear after puerperium [4]. The majority of women recover from pregnancy-related low back pain within 3 months of delivery [5]. However, postpartum follow-up studies have shown that between 8–20% of women still have persistent non-specific low back pains 2–3 years after delivery that interferes with daily activities [6,7]. Women who still complain from pain at 3 months are considered at risk for persistent pain [5]. The evaluation of lumbopelvic pain postpartum is mostly based on self-administered questionnaires or interviews, and the lumbopelvic pain is occasionally assessed by clinical evaluation [6,8]. In addition, postpartum follow-ups seldom include the entire initial pregnant cohort [8], which may be important since the debut of lumbopelvic pain may present even in relation to delivery [9]. In the past it was widely believed that bed rest was the best cure for acute low back pain. Trends are now moving away from that old way of thinking and exercise is now being prescribed for treatment [10]. Osteopaths and other Manipulative Therapists developed Muscle Energy Technique (MET) beginning with Fred Mitchell, in the 1950s, which started with the pelvis. They are a gentle but highly effective treatment of musculoskeletal dysfunction. MET uses isometric or isotonic contractions as a way of lengthening tight muscle; strengthening weak muscle; mobilizing joints and relieving congestion in the tissues. Good quality results require skilled application and an accurate diagnosis of muscle condition [11]. 5254 British Journal of Medicine & Medical Research, 4(33): 5253-5261, 2014 Muscle energy technique (MET) aims to normalize soft tissue structures, such as shortened or tight muscles with no direct implication to the joint associated with these soft tissues. MET can be used to improve joint mobility by influencing soft tissues dysfunction through relaxing tight tense musculature, spasms, or fibrotic changes [12,13]. Muscle energy technique (MET) has been defined when the patient uses her force against the therapist’s counterforce. The therapist brings the area of treatment to a pain free end range barrier by taking up the slack of the available soft tissue. Once the patient is brought to the pain free end range barrier the therapist will request the patient to use his/her muscles to resist or push back against the therapist [12]. Muscle energy technique (MET) is a common conservative treatment for pathology around the spine, particularly lumbopelvic pain (LPP). MET is considered a gentle manual therapy for restricted motion of the spine and extremities and is an active technique where the patient, not the clinician, controls the corrective force. This treatment requires the patient to perform voluntary muscle contractions of varying intensity, in a precise direction, while the clinician applies a counterforce not allowing movement to occur. For many years, MET has been advocated to treat muscle imbalances of the lumbopelvic region such as pelvis asymmetry. The theory behind MET suggests that the technique is used to correct an asymmetry by targeting a contraction of the hamstring or the hip flexors on the painful side of the low back and moving the innominate in a corrected direction. It is worth noting however, that evidence suggests that non-symptomatic individuals have also been shown to have pelvis asymmetries. Despite this, MET is frequently used by manual therapy clinicians [14,15]. Muscle energy technique (MET) is an effective conservative modality to alleviate lumbopelvic pain. The touch of the clinician, along with stimulation of agonist and antagonist muscles, seems to decrease perception of pain. This technique could be applied prior to other rehab techniques, such as strengthening exercises, to decrease pain and enhance the effect of applied exercise program. There are many advantages for applying MET, that it takes a very short time to be applied (less than 1 minute). It also allows the clinician to have physical contact with the patient. Lastly, MET is a low-force isometric contraction in a pain- free position. Finally, this technique is not painful or harmful to the patient [16]. Unfortunately, few studies have examined the effectiveness of MET. Previous research has found that MET combined with other conservative modalities such as, massage and resistance exercises may be effective for decreasing disability and improving function in patients with acute low back pain, but the effect of MET as an isolated treatment has not been determined [15]. Therefore, the aim of this study was to investigate the effect of MET on post –n at allow back pain. 2. MATERIALS AND METHODS A randomised controlled trial design was used for the purposes of the current study. Patients were randomised to either group A (MET group) or B (sham technique group) by simple randomization using the envelope method. Accordingly, a pack of sealed envelopes including a card with either the word ‘MET’ or ‘Sham technique' written on it, was given to a staff physical therapist unrelated to the study; she picked one envelope after patients agreed 5255 British Journal of Medicine & Medical Research, 4(33): 5253-5261, 2014 to take part in the study. Depending on which card was selected patients were allocated to their respective group. This study was carried out upon forty women diagnosed as postnatal low back pain. They were selected from Outpatient Clinics of Gynecology of Ain Shams University Hospital. Their age ranged from (25-35) years and BMI<30kg/ m², they were all after normal vaginal delivery using local anaesthesia. Group (A) consisted of twenty subjects, with an average age (29.2±1.9Yrs), and BMI (27.28±2.1kg/m 2) who received MET. Group (B) consisted of twenty subjects, with an average age (28.58±2.2Yrs), and BMI (28.92±0.7kg/m 2) who received sham technique. Exclusion criteria included low back pain lasting longer than 6 weeks, radicular pain distal to the knee, previous low back surgery, low back pathology diagnosed by a physician, spondylolisthesis and chronic low back pain. A hot pack was used for 15 minutes in a prone position for both groups (A&B) before the treatment. Hot packs were used to heat small areas, and allow for decrease pain, muscle spasm, and provide vasodilatation of the blood vessels supplying the area.
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